Radiation therapy or the monoclonal antibody drug rituximab (Rituxan) may treat and even cure follicular lymphoma if it’s diagnosed very early.
But most people are diagnosed when their cancer is already advanced. To treat advanced lymphoma, your doctor can prescribe a combination of different therapies.
Some people have follicular lymphoma that returns after treatment or causes complications. They may need a series of therapy combinations over time. This depends on the size of their tumors, their symptoms, their age, or their general health.
Because follicular lymphoma is often a slow-growing cancer, you may choose watchful waiting instead of radiation or a drug at first.
During watchful waiting, you’ll have regular checkups with your doctor. If your disease seems stable and you feel good, you can put off radiation or drug therapy. After you watch and wait for a while, you may need some type of combination therapy.
Combination chemotherapy, or “chemo,” is a common treatment for follicular lymphoma. You take different chemo drugs together along with a steroid or a monoclonal antibody to kill or slow the growth of lymphoma cells. Other names for this treatment are multiagent chemotherapy and chemo-immunotherapy.
Chemo combination therapies include:
- CHOP: cyclophosphamide, doxorubicin (also called hydroxydaunorubicin), vincristine (Oncovin), and prednisone
- CVP: cyclophosphamide, vincristine, and prednisone
Often, you’ll take CHOP along with rituximab, called CHOP-R, or CVP with rituximab. You may also have chemo combined with a newer antibody drug, obinutuzumab (Gazyva).
Other chemo combination therapies include:
- Rituximab with bendamustine
- Obinutuzumab with bendamustine
- Chlorambucil (Leukeran) with rituximab
- Lenalidomide (Revlimid), a targeted therapy, with rituximab, a combination called R2
Antibody therapies and kinase inhibitors
You’ll likely take rituximab or obinutuzumab as maintenance therapy for up to 2 years after you’ve finished chemo. This is to keep your cancer in remission. Both of these drugs may treat your follicular lymphoma if it’s relapsed (has come back after treatment) or refractory (not responsive to treatment).
Newer drugs called kinase inhibitors are now approved to treat relapsed or refractory follicular lymphoma:
- Idelalisib (Zydelig)
- Copanlisib (Aliqopa)
- Duvelisib (Copiktra)
- Umbralisib (Ukoniq)
There’s also a new drug called tazemetostat (Tazverik) for relapsed or refractory follicular lymphoma. You take it if your tumors test positive for a genetic mutation called EZH2. It’s called an EZH2 inhibitor. Again, you try this therapy after other chemo combinations have failed.
Another combination therapy for follicular lymphoma combines radiation with a monoclonal antibody (also called immunotherapy). These antibodies seek out lymphoma cells. The combination therapy attacks and kills these cells.
Radioimmunotherapy combinations approved to treat relapsed or refractory follicular lymphoma include:
- Iodine-131 and tositumomab (Bexxar)
- Yttrium-90 and ibritumomab tiuxetan (Zevalin)
Some people with follicular lymphoma have radioimmunotherapy before they try any other cancer treatment.
Bone marrow or stem cell transplant
Another treatment for follicular lymphoma is surgery that transplants stem cells from you or a donor.
Stem cells are a special kind cell found in bone marrow, so this treatment is also called bone marrow transplant or hematopoietic stem cell transplantation (HSCT). Stem cells are transplanted to replace your own damaged stem cells. They grow and help your body make more of the healthy blood cells that it needs.
Stem cell transplant often is used only in younger people with follicular lymphoma, or in people with relapsed or refractory cancer. First, you’ll have high-dose chemotherapy. Sometimes you’ll have radiation therapy too. Then, doctors will transfuse healthy stem cells into your blood.
After a stem cell transplant, you may need a blood transfusion, because chemotherapy and radiation lower your levels of red blood cells and platelets. You may also need to take antibiotics to head off infections while your body recovers.
CAR T-cell therapy
This is one of the new treatments for relapsed or refractory follicular lymphoma. Your doctor may try it if you’ve already had two chemotherapies that haven’t worked. It takes immune cells from your blood (T cells) and genetically modifies them to add receptors called chimeric antigen receptor (CAR) to their surface. This makes them better able to find and destroy cancer cells. The changed cells are then put back into your blood. These cells can live in your body and fight cancer for many years.